1437ty NOTt
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
( r('lf:Yt�Y1ii—w,..v.}.WMyc... �t.�*rp�.i.M.+1s'Mu.A.1E.•�.
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Subdivision Improvement Permit — Class III
DATE: May 15, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 623 Scraper 15' high ' Sketch (attach construction plans -if appropriate)
1111011 widA 12nipan1 1ha.
DESCRIPTION OF CONSTRUCTION ROME: 52nd And Washington north
out of City limits. '
DIMENSION OF INSTALLATION OR REMOVAL ` DATE: May 15, 1992.
1 '
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal' of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration'ofthe granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La ouinta and to pay for any additional replacement necessary as the result of this work.
r
Signature of Applicant or Agent
Tarmac'California P.O. Box 14050 Palm Desert CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
On file.
Name of Contractor and Job Foreman Business Address Telephone No.
On file On file
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1437'
Minor Improvement•Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$
10.00
$ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1437
DATE APPROVED 5/15/92
EXPIRATION DATE 5/15/92
DATE ISS ED 5/.15/912
By _
Ad kinistrative Authority
TELEPHONE: (6(91)564-2246
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